Effect of different renal function on clinical outcome of oral anticoagulant drugs in patients with nonvalvular atrial fibrillation
Objective To analyze the effects of oral anticoagulants on major bleeding events and ischemic stroke within 1 year after discharge under different baseline renal function.Methods The retrospective study method was applied.A total of 1 893 AF patients treated in our hospital from January 2022 to September 2022 were selected.All patients were treated with OACs.Glomeruar filtration rate(GFR)staging of CKD according to the American Kidney Disease Founda-tion(NKF)Quality of Life Guidelines for Kidney Disease(KDOQI)Working Group Renal/Dialysis Clinical Practice Guidelines,patients were divided into 5 groups according to baseline renal function:group 1,Normal kidney function,GFR≥90 mL(min·1.73m2);group 2,Hyporenal function,GFR60-89 mL(min·1.73m2);group 3,Moderately abnormal renal function,45-59 mL(min·1.73m2);group 4,Moderate to severe renal dysfunction,30-44 mL(min·1.73m2);group 5,Severe renal dysfunction,15-29 mL(min·1.73m2).Baseline data and clinical outcomes of the 5 groups were compared.Logistic regression was used to analyze the factors of anticoagulant drugs affecting the clinical outcome of patients.Results Compared with group 3,group 1 and group 2 were the protective factors of ische-mic stroke in patients treated with warfarin;group 4 and group 5 were the risk factors of ischemic stroke in patients trea-ted with warfarin.Compared with group 3,group 1 and group 2 were the protective factors of major bleeding events in pa-tients treated with warfarin;group 4 and group 5 were the risk factors of major bleeding events in patients treated with warfarin.Compared with group 3,group 1 and group 2 were the protective factors of ischemic stroke in patients treated with apixaban;group 4 and group 5 were the risk factors of ischemic stroke in patients treated with apixaban.Compared with group 3,group 1 and group 2 were the protective factors of major bleeding events in patients treated withapixaban;group 4 and group 5 were the risk factors of major bleeding events in patients treated with apixaban.Compared with group 3,group 1 and group 2 were the protective factors of ischemic stroke in patients with dabigatran;group 4 and group 5 were the risk factors of ischemic stroke in patients treated with dabigatran.Compared with group 3,group 1 and group 2 were the protective factors of major bleeding events in patients treated with dabigatran;group 4 and group 5 were the risk factors of major bleeding events in patients treated with dabigatran.Conclusion Renal function significantly affects the safety and efficacy of oral anticoagulants.
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